This invention relates to the general field of medical devices, and more particularly to an apparatus for facilitating endoscopic medical and surgical procedures.
A basic tenent of modern surgery is to perform the necessary surgical procedure on the patient with minimum disturbance and destruction to intervening tissues and organs. Thus, endoscopes are finding a large role in surgery, giving the surgeon access to many parts of the body with minimum disturbance to intervening tissues by incision. For procedures performed in many body cavities (e.g. bronchus, lung, esophagus, etc.) access through an endoscope avoids completely the need for surgical incisions and the resulting trauma to the patient.
Specific endoscopes are available for access to particular body cavities. For example, bronchoscopes, sigmoidoscopes, gastroscopes, etc. are all available. The primary difference in these devices lies in the size. The general configuration and method of use are not essentially different from scope to scope. We will use the term "endoscope" herein as a generic term to indicate any such device.
A major disadvantage in performing surgery through an endoscope is the limited access the surgeon has to the surgical field. Thus, suction, irrigation, biopsy, incisions, and any other surgical procedures must compete for limited space in the typical endoscope channel. More and more surgery is being performed by means of laser light directed to the patient by an optical fiber passed through an endoscope. This adds to the demands for space in the endoscope channel, particularly as such modern procedures as photodynamic cancer treatments emerge from clinical tests into general use.
Endoscopes are made in a rigid configuration and also made flexible such that the surgeon can control the direction of the endoscope tip inside the patient's body, typically by means of a control wheel close to the eyepiece. The flexible endoscope is certainly more versatile in performing surgical procedures, but exacerbates the problems of access to the surgical field. That is, typical rigid endoscopes have more space for access by the surgeon. For this reason, the primary emphasis of the present invention is on flexible endoscopes. However, the use of the present device for rigid endoscopes is obvious in those cases in which it would be useful for the surgeon. Typically, however, the surgeon using a rigid endoscope would not have the severe limitations on access the present invention is intended to relieve.
The typical flexible endoscope has several devices and access ports mounted close to the eyepiece, easily accessible to the surgeon and assistant. In addition to the eyepiece for viewing the surgical field through optical fibers, there is typically a control wheel by means of which the surgeon can direct the tip of the endoscope to the desired location within the patient. There is also an illumination port through which light is delivered to the surgical field for viewing by the surgeon.
Such endoscopes typically have suction applied through the endoscope channel. Typically, suction is applied continuously to an inlet in the endoscope, near the eyepiece. The suction is not usually directed to the surgical field, having a nearby suction port connected to the suction inlet and open to the atmosphere. However, merely by covering this suction port, the surgeon can apply suction to the surgical field at will.
The more recent models of endoscopes have yet another access port through which the surgeon can access the tip of the endoscope. This is frequently called a "biopsy channel" since it can find use for removing a sample of tissue for analysis. When used for viewing and sampling a region of the patient, access through the biopsy channel by a biopsy device is typically adequate. However, as more and more surgery is performed through endoscopes, access by means of a single channel places a severe constraint on the surgeon. For example, in the performance of laser surgery or photodynamic therapy through the biopsy channel of the endoscope, there is no convenient way to irrigate the surgical field. For the laser surgeon to have irrigation of his working field, typically the surgical device must be removed, irrigation performed, and the device replaced and surgery continued. This obviously is tedious for the surgeon. More importantly, it prolongs the duration of surgery for the patient including the patient's time under anesthesia.
The present device is an adapter for endoscopes allowing the biopsy channel to perform irrigation as well as another (typically laser) procedure at the same time. Thus, by using the present device, the surgeon can keep the optical fiber in place in the biopsy channel for performing the procedure, quickly have irrigation of the field when needed, and promplty return to the procedure with minimal interruption for the irrigation. The result is a marked increase in convenience to the surgeon, and a more rapid (hence, safer) procedure for the patient.